Provider Demographics
NPI:1578661195
Name:DILLON, DENNIS (PA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:DILLON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 MONTAUK HWY
Mailing Address - Street 2:STE 1
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4437
Mailing Address - Country:US
Mailing Address - Phone:631-422-9530
Mailing Address - Fax:631-376-1208
Practice Address - Street 1:400 MONTAUK HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4429
Practice Address - Country:US
Practice Address - Phone:631-482-9192
Practice Address - Fax:631-482-9195
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006337207X00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY970027340OtherRAILROAD MEDICARE
NY970027340OtherRAILROAD MEDICARE